St. Joseph Hospital
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the applicable Joint Commission standards.
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St. Joseph Hospital’s 5K Run/Walk in Honor of
Navy SEAL Lt. Michael P. Murphy

Sunday, September 19, 2010 - 9:00 a.m.
Bethpage State Park Polo Field

Pre-registration payment must be received by September 15th.

Checks should be made payable to:

St. Joseph Hospital
c/o Halina Carrigan
4295 Hempstead Turnpike
Bethpage, NY 11714

Please call (516) 520-2301 or email hcarrigan@nihli.org for more information.

Prefix


First Name (req.)


Last Name (req.)


Company


Address



City, State Zip
,

Age


Date of Birth
(mm/dd/yyyy)

Gender


Status


Email Address (req.)


Entry Fee $25.00 (Deadline is 9/11/10)
Day of race registrations are $30

Sponsorship


Disclaimer:
I, the undersigned, intending to be legally bound, hereby, for myself, my heirs, my assigns, executors, and administrators, waive and release any and all claims for damages I may have against New Island Hospital, and all other sponsors of the Run, The Long Island Track and Field, the State of New York, the Town of Oyster Bay, and their employees, agents, representatives, successors and assigns, from any and all liabilities, claims, demands and causes of action whatsoever arising directly or indirectly from my participation in this event, even if any such liabilities, claims, demands and causes of action arise in whole or in part out of the negligence of any of the above-mentioned organizations or individuals. I attest and verify that I am physically fit and have trained sufficiently for the completion of this event, and that my physical condition has been verified by a licensed Medical Doctor. If signed by a parent, the parent agrees to release and hold the above named organization and personnel harmless from and against any claims and rights, which may be asserted on behalf of the entrant. I hereby grant permission to any and all of the foregoing organizations and personnel to use photographs, or any other record of this event for any purpose whatsoever.